Illnesses & Symptoms
Acne (aka pimples, comedones, whiteheads, blackheads, or zits) is a common problem in teens that we treat in our office.
Acne is caused from hormones, bacteria and oils in the skin. Pressure from helmet straps or tight clothing can irritate skin and contribute to acne. Some drugs, such as steroids, worsen acne. Acne is not caused from sweat, dirt or foods.
It is commonly seen on the face, chest and back. Do not "pop" acne! This can make it worse or lead to scarring! Early treatment might not prevent worsening of acne if there is a genetic predisposition to severe acne. Acne treatment should begin when the person with the acne (not the parent) desires to begin. Parents may gently ask if acne bothers a teen, but constant "nagging" about washing is not helpful and may lower self esteem. Good skin care is reviewed below. Even with the best skin care and treatments, it takes 6-8 weeks to clear acne, so patience is the key.
Mild acne can be treated at home with cleaning the face properly twice daily. If you are washing in the shower, wash (and condition) hair first so no hair products rinse onto cleaned acne-prone skin. Wash acne prone areas with a gentle cleanser. If you use specific acne washes (such as products with benzoyl peroxide or salicylic acid), leave the wash on your skin for 30 seconds before rinsing. Do not use harsh abrasives to clean your skin. This damages the skin integrity and can worsen acne. In general, masks and astringents are not found to be helpful.
Allow your face to dry completely before applying any creams, whether prescription or over the counter. This helps the medication work better. Common over the counter products contain benzoyl peroxide or salicylic acid. New on the market is Differin gel, previously only available by prescription. Choose the salicylic acid option if you have dry skin. Remember that benzoyl peroxide can bleach clothing or linens, so be careful with it! If your face is dry, using the products every other day initially can help prevent excessive dryness.
Use moisturizers that are non-comedogenic (also called water-based or oil-free) and in the morning use one with sunscreen. If your skin gets overly dry, it tries to make more oil, which can make more acne, so do not be afraid to use moisturizers!
When choosing makeup, avoid cream foundations. Powders tend to cause less skin irritation.
When to see your provider
If home remedies do not help after 6-8 weeks (or if there is a negative reaction to over the counter ingredients), prescription medications are useful. We use many topical medications, including antibiotic creams and retinoid medicines that help remove old skin cells and remove the keratin that plugs the hair follicles. Oral antibiotics are sometimes used for a short or long duration, depending on severity of acne. Many females respond to hormonal therapy (birth control pills) because acne is so dependent on hormone cycles.
When to see a dermatologist
If the above prescription therapies do not resolve (or greatly improve) acne, we can refer to dermatologists to consider isotretinoin (Accutane). This is a powerful treatment reserved for scarring acne that does not respond to other medications. Cholesterol levels and liver tests must be monitored during its use. Females must submit to pregnancy tests and take oral contraceptives during its use because of severe birth defects.
Although acne can be very annoying, with proper care and time most can be treated with good results by your pediatrician. We often see patients who want to see a dermatologist immediately, but even isotretinoin can take weeks to months to have a good effect, and it is used only when other treatments fail after months of regular use. Most people get acne at some point in their lives, so we all understand how important it is to get rid of the pimples, but it takes patience above all else! If you do not find the over the counter remedies working after 6-8 weeks of daily use, make an appointment with your provider. If results are not sufficient after another 6-8 weeks, make another appointment with your provider to review the care and discuss treatment changes that can improve outcome.
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